To: Mark T Bertolini, CEO, President Donald Trump, The Florida State House, The Florida State Senate, Governor Ron DeSantis, The United States House of Representatives, and The United States Senate
AETNA: PROFIT OVER PATIENT CARE!
Insurance members need to demand that insurance companies listen to the doctors and patient requests for procedures. They should also expedite the appeals process and pay the member full pay while the appeal is in process. The member should not have their pay reduced because the insurance company is slow in responding to the member’s appeal and the insurance company. Aetna, in this case, is motivated by their profits and not my health.
Why is this important?
I now use a wheelchair due to pain. Aetna has denied a pre-certification from my orthopedic surgeon for a Sacroiliac Joint Fusion. Aetna determined that this potential pain-reducing procedure is not medically necessary. The National Institute of Health has published articles demonstrating the high success of pain reduction of both open and minimally invasive SI Joint Fusion, although minimally invasive has a higher success of pain reduction. Also, implanted instrumentation used in these types of procedures has been approved by the FDA. Aetna uses MCG guidelines to determine this surgical procedure. MCG criteria is motivated to reduce expenses and increase insurance companies’ profits through their products which is why 8 of 10 largest US health plans utilize their services (if they didn’t produce results, MCG would not have clients). Aetna has further denied my surgeon's request for the procedure after the peer to peer review and is slow to respond to my written appeal keeping me in debilitating pain and reducing my pay while I am out on disability.